Opinion: Are Physicians Prepared to Treat Chronic Pain? Not Always

Opinion: Are Physicians Prepared to Treat Chronic Pain? Not Always

Terri A Lewis, PHDTerri Lewis PhD studies how the US Health Care System works (not so well she would tell you) for people impacted by chronic illness. She is also the daughter and the mother of a chronic, intractable pain patient, so her passion for this topic is fundamental to what she is as a human being.

Two recent entries into the virtual world of information release suggest that physicians are not prepared to deal with persons who require the coordination of health care supports for their complex needs. A third suggests progress, but not enough progress.

The first, a new survey culled data from more than 11,000 primary care physicians in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The US has the highest incidence of chronic disease, but ranks near the middle or bottom for physician preparedness to deal with this complexity according to responses.  In the United States, primary care doctors include general and family physicians, internists and pediatricians. The report exposed gaps in care coordination, communication, access to care and use of information technology across the 10 industrialized nations.  Responses indicate the USA ranks from the middle to the bottom in relationship to other countries.

The second, by Moulds and friends, finds that primary care physicians in ten countries are ill prepared to deal with the needs of an aging population with increasingly complex needs for care. Job-related stress, perceptions of declining quality of care, and increasing administrative burden indicate the need to monitor the outcomes of front-line perspectives as health reforms are conceived and implemented.

Another survey conducted in 2010, found that almost one-quarter of family medicine residency training programs provided some training in Community Health Centers or CHCs. However, the proportion of residencies providing continuity training in CHCs – the type of training associated with enhanced recruitment and retention of family medicine graduates in underserved areas – was limited and remains relatively unchanged since 1992.   While the federal government has called for changes in medical education in several areas, including residencies, some training institutions have been very slow to implement or redesign these necessary adaptations into their curriculums.

As pain physician Dr.Richard Radnovich of Boise, Idaho indicates, there is progress.  Whether it is enough progress to keep up with the changing needs of a rapidly aging population is the question.  If we are continuing to perpetuate a maladaptive response to the future treatment needs of the population we have, then we need to examine whether we are doing enough or whether we are measuring the indicators that allow us to dial in necessary refinements.

From the perspective of patients who need coordinated care, our current approaches foster the delivery of too little care in a way that is too late to be effective and indirectly, it may contribute to escalating harm.  And even now, the indicators we can measure tell us that we need to be looking closely at these issues as a factor in under treatment of chronic pain, increasing reliance on unproductive and dangerous use of polypharmacy and fail first approaches. If we have built a system that cannot readily respond to the needs of the population because of the way in which it is designed, then we need to look closely at how to reset this state of affairs.

As a care partner, I am shoulder deep in dealing with the effect of these issues. I welcome the opportunity to have this discussion.

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Authored by: Terri A Lewis, PhD.

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The medical field certainly needs more education in chronic pain but how do you do that without first studying chronic pain and I feel more needs to be done in this area.There are so many different types of chronic pain and people generally don’t think about that. Age is a factor. Of course a older persons pain is going to get worse as parts of their body change. For example I am 63 and in horrendous pain 24/7 gradually getting worse over the past few years. I ignored pains for many years until I just couldn’t function anymore. I have been to more doctors and pain clinics than I can count with more diagnosis’s than you can imagine. After my hip surgery and my back getting progressively worse I had every injection known, PT, medications etc. Finally the real answer was, we have done all we can do at your age with the amount of OA you have. So instead of continuing these appointments that did nothing to help me I turned to my primary care doctor and get my vicodin and xanax from him. Why?? Because this man has known me for a long time and has witnessed the changes and actually cares. He keeps up with my blood work and anything else I need which none of the others cared about. He knows me. He would know if he saw a significant change and I trust him. Is he a God? No, and that seems to be what people are looking for in a doctor If they shrug at your pain or just try to make you think it’s in your head because they have no answers, you are seeing the wrong doctors. My doctor really cares about his patients and what is new to learn out there as he is off to seminar’s all the time. Work together to help people with chronic pain by studying chronic pain more. I am to old to have to endure what some patients do.

Barbara Washington MD

Thank you for your report. I had the experience of lack of care coordination with my mother. I am a cardiologist. Over the Thanksgiving holiday, my mother could not getc her Vicodin for over a week. She has history of RA and MI. A recent fall set her back. She was in so much pain ,her BP was over 200/100 mm Hg. She did not let family know she was in pain. When the RA office was contacted, they said Rx had been at pharmacy. Our medical system is broken. I am a different doctor. Empathy for what families go through has increased. Caregiver burnout is real.

Kristine (Krissy)

Thank you, Terri, you bring up some very important and timely points.